Front Cover 1
Pediatric Ophthalmology 2
copyright 
3 
Contributors 6
Contents 8
Pediatric Clinics Of 
 
11 
Foreword 12
References 13
Preface 14
A Child’s Vision 16
Key points 16
Introduction 16
What is normal visual behavior? 16
How to assess an infant’s vision 17
The red reflex test 18
Nystagmus 20
Delayed visual maturation 20
Cortical vision impairment 20
Vision screening 21
Instruments for vision screening 21
Summary 23
References 23
Amblyopia 26
Key points 26
How well do glasses alone treat amblyopia? 27
Do we really know that patching works? 27
How many daily hours of prescribed patching are necessary? 27
What happens when patching stops? 32
Does patching work in older children? 32
Does atropine work as well as patching? 32
How often does atropine need to be used? 32
l-Dopa in the treatment of amblyopia 32
Screening for amblyopia 33
Classification 35
Diagnosis 35
Treatment 36
Complications 37
Summary 37
References 37
Pediatric Refractive Surgery 40
Key points 40
Introduction 40
Historical perspective 40
Refractive surgery procedures today in adults 41
Low-to-moderate Myopia and Low Hyperopia 41
High Myopia 41
Moderate-to-high Hyperopia 42
Challenges of pediatric refractive surgery 42
Indications for Treatment 43
Patient Cooperation 45
Desired Postoperative Correction 45
More Challenging Refractive Errors 45
Future role of refractive technology in children 46
Refractive Surgery in the Adolescent Population 46
Identifying and Treating Highly Anisometropic Eyes Earlier 46
Summary 46
References 46
The Lacrimal System 50
Key points 50
Definition and anatomy 50
Physiology and function 51
Embryology and development 52
Congenital disorders and treatment 52
Congenital Nasolacrimal Duct Obstruction 52
Clinical features 52
Management 53
Nonsurgical 53
Surgical 53
Congenital Dacryocystocele (Dacryocele) 55
Clinical features 55
Management 55
Congenital Lacrimal Fistula 55
Clinical features 55
Management 55
Congenital Alacrima 56
Congenital Paradoxic Gustolacrimal Reflex (Crocodile Tears) 56
Atresia of the Punctum or Canaliculus 56
Lacrimal Gland Choristoma 56
Acquired disorders and treatment 57
Dacryocystitis 57
Dacryoadenitis 57
Canaliculitis 57
Punctal or Canalicular Stenosis 57
Association with Facial Abnormalities 57
Clinical assessment 57
History and External Examination 57
Testing 58
Pediatricians’ and ophthalmologists’ tests 58
Dye disappearance test 58
Lacrimal sac compression 58
Ophthalmologists’ tests 58
Tear breakup time (TBUT) 58
Schirmer I and Schirmer II test 58
Jones I and Jones II test 58
Irrigation 58
Dacryocystogram 59
Nasal endoscopy 59
Computed tomography and magnetic resonance imaging 59
References 59
Periocular Hemangiomas and Lymphangiomas 62
Key points 62
Introduction 62
Hemangioma 63
Extent of Problem 63
Cause, Contributory Factors, Risk Factors 64
Sequelae of the problem 64
Clinical Assessment 65
Kasabach-Merritt Syndrome 66
PHACE Syndrome 66
Management 66
Pretreatment considerations 67
Induction of systemic propranolol 68
Monitoring 68
Lymphangioma (lymphatic and venous-lymphatic malformations) 69
Extent of Problem 69
Cause, Contributory Factors, Risk Factors 70
Sequelae of the Problem 70
Clinical Assessment 70
Management 70
References 72
Genetics and Ocular Disorders 76
Key points 76
Introduction 76
Selected clinically important ocular phenotype/genotype correlations 77
Lids 77
Lymphedema-distichiasis syndrome 77
Cornea 77
Corneal lesion and trisomy 8 mosaicism 77
Iris 77
Iris anomalies and ACTA2 77
Lens 78
Vitreous 78
Vitreous anomaly and stickler syndrome 78
Retina 78
Leber congenital amaurosis 78
Photophobia 79
Nyctalopia 79
Optic Nerve 79
Glaucoma 80
Development of groupings of diseases and syndromes based on cellular events or pathways 80
Ciliopathies 80
RASopathies 82
Overview of genetic testing and principles 82
Karyotype 82
Microarray-Based Technologies 82
Sequencing 83
Deletion/Duplication Studies 84
New therapies for genetic eye disease 84
Summary 85
References 85
Retinopathy of Prematurity 88
Key points 88
Introduction 88
Extent of the problem 88
Cause/contributory or risk factors 89
Sequelae 89
Clinical assessment 90
Management 92
Summary 94
References 94
A Review of Pediatric Idiopathic Intracranial Hypertension 100
Key points 100
Introduction 100
Nomenclature 101
Demographics 101
Associated conditions 101
Clinical presentation 101
Evaluation 102
Diagnostic criteria 105
Workup 106
Treatment 107
Emergent treatment 108
Pharmacologic treatment 108
Surgical treatment 108
Summary 109
References 109
The Pediatric Red Eye 112
Key points 112
Etiology and contributory or risk factors 112
Tools to evaluate the red eye 112
History 113
The red eye causes and treatments 113
Viral Conjunctivitis 113
Pharyngoconjunctival fever 115
Herpetic eye disease 115
Molluscum contagiosum 117
Bacterial Conjunctivitis 117
Treatment 117
Neonatal Conjunctivitis 118
Cellulitis 119
Treatment of cellulitis 119
Inflammatory Conjunctivitis 120
Uveits 120
Chalazion 120
Blepharitis 121
Structural 121
Trauma and Foreign Body 124
Corneal abrasion or foreign body 124
Contact lens wear 125
Trauma 125
Toxic and Chemical Exposure 125
References 126
Allergic Eye Disease 128
Key points 128
Introduction 128
Classification 131
Seasonal Allergic Conjunctivitis 131
Epidemiology and risk factors 131
Pathophysiology 131
Clinical presentation 131
Perennial Allergic Conjunctivitis 131
Epidemiology and risk factors 131
Pathophysiology 131
Clinical presentation 131
Vernal Keratoconjunctivitis 131
Epidemiology and risk factors 131
Pathophysiology 132
Clinical features 132
Atopic Keratoconjunctivitis 133
Epidemiology and risk factors 133
Pathophysiology 133
Clinical features 133
Contact Blepharoconjunctivitis 134
Epidemiology and risk factors 134
Pathophysiology 134
Clinical features 134
Giant Papillary Conjunctivitis 135
Epidemiology and risk factors 135
Pathophysiology 135
Clinical features 135
Clinical assessment 135
History 135
Examination 135
Differential Diagnosis 136
Management 136
Sequelae of the problem 137
Acknowledgments 140
References 140
Convergence Insufficiency and Vision Therapy 142
Key points 142
What are the symptoms of CI? 143
How to test convergence and diagnose CI 143
Secondary causes of convergence insufficiency 144
Who needs treatment for CI? 145
What is the treatment for CI? 146
Controversies over vision therapy between the optometric and ophthalmic communities 147
Learning disabilities 147
Summary 149
References 150
Index 152